Full Utilization of Nurse Practitioners: Helped by Laws, Hindered by Health Care Culture

Jan 16, 2014, 9:00 AM

Efforts to expand the role of nurse practitioners (NPs) to help address the country’s shortage of primary care providers have been bolstered by legislation in several states. But laws expanding scope of practice may not do all they could to relieve the nation’s primary care crisis, according to a new study by researchers at the Columbia University School of Nursing, which suggests that the culture in health care settings can impede full utilization of NPs.

The study, published in the Journal of Professional Nursing, was conducted in Massachusetts, where state health reform increased demand for primary care and legislation recognized NPs as primary care providers. Researchers found that gains made by government can be neutralized by formal and informal practices at health care organizations. For example, the study cited instances where NPs were not allowed to conduct physical assessments or see new patients.

“Organizational policies can often trump governmental policies, keeping the contribution of the nurse practitioner unrecognized and preventing them from making the fullest contribution possible to effective patient care,” lead researcher Lusine Poghosyan, PhD, RN, an assistant professor of nursing at Columbia and a Robert Wood Johnson Foundation Nurse Faculty Scholar, said in a news release.

The study also investigated the support and resources available to NPs, who reported that they were often denied the personnel and resources provided to physicians, including medical assistants, administrative staff, and sufficient exam room space. NPs in the study said that their role was poorly understood by senior leadership. This lack of understanding emerged as a contributor to what the researchers call NP “invisibility.”

The research team recommends that administrators clearly define ways for NPs to be included on the decision-making committees; and that health care practices provide adequate access to resources to ensure efficient use of NPs’ time and skills. And, researchers said, organizational and policy structures should demonstrate the contributions of NPs to patient care and promote continuous contact with patients.

Time may help improve the experiences of NPs in primary care, the study suggests. Most NPs reported that the longer they worked with physicians, the more trust and autonomy to practice independently grew.

Read the study in the Journal of Professional Nursing.
Read the Columbia University School of Nursing news release.
Read more about states loosening restrictions on nurse practitioners.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.